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10 years after state budget impasse, human services in Illinois again brace for ‘tsunami’

Cortnie Stewart, who suffered a traumatic brain injury in a 1997 car crash, looks up at her mother Judy Stegle at their home in Jonesboro, Illinois. A nearby nonprofit provided respite services to aid in her full-time care before closing as result of the budget impasse.
(Julia Rendleman, Capitol News Illinois)
Cortnie Stewart, who suffered a traumatic brain injury in a 1997 car crash, looks up at her mother Judy Stegle at their home in Jonesboro, Illinois. A nearby nonprofit provided respite services to aid in her full-time care before closing as result of the budget impasse.

This story is a collaboration between the Illinois Answers Project and Capitol News Illinois.

JONESBORO, Ill. — It was a bitterly cold evening on Jan. 19, 1997, when Judy Stegle and her husband, Mike, received the call that would upend their lives forever.

Their 17-year-old daughter, Cortnie Stewart, a softball and basketball standout at Anna-Jonesboro Community High School, a gifted painter with a spunky attitude, had taken the car without permission to drive to Harrisburg. She hit black ice and the car landed on her after she was thrown from the vehicle. When the ambulance arrived, she was unconscious.

Cortnie woke up 13 days later in a hospital in Cape Girardeau, Missouri.

“She opened her eyes and she saw me, and she started crying,” Judy Stegle said. “And they said, ‘Well, that's great that she has emotions.’”

But Cortnie had suffered extensive brain damage. She’d never speak again, or feed herself, or go to the bathroom without help. She would live, but she would need round-the-clock care for the rest of her life.

A few years later, the Stegles reached out to the Delta Center, which provided respite care services. That meant even just a few hours a week where someone from the Cairo-based nonprofit organization could step in for the Stegles. Enough time for Judy Stegle to run to the doctor, get her hair done, maybe grab a meal with her husband at the local Dairy Queen.

Then, in 2015, the Delta Center closed, becoming one of the earliest casualties of Illinois’ two-year budget impasse, which began a decade ago this summer — a product of the political struggle between Republican Gov. Bruce Rauner and Democrats who controlled the General Assembly.

Just over a month into the impasse, the nonprofit’s respite care program that helped the Stegles and more than 50 other families in Southern Illinois ended and never returned.

“The state of Illinois … is pretty crappy,” Judy Stegle said. “There's just no help out there for anything.”

Judy Stegle, 72, has been the primary caretaker for her daughter Cortnie Stewart since the high school senior suffered a traumatic brain injury during a car crash in 1997. The family has struggled to find in-home help since the Delta Center in Cairo closed shortly after Illinois’ budget impasse began in 2015.
(Julia Rendleman for Capitol News Illinois)
Judy Stegle, 72, has been the primary caretaker for her daughter Cortnie Stewart since the high school senior suffered a traumatic brain injury during a car crash in 1997. The family has struggled to find in-home help since the Delta Center in Cairo closed shortly after Illinois’ budget impasse began in 2015.

The Stegles were far from alone in their experience; organizations that provided child welfare, housing, mental health care, alcohol and drug addiction services, food for poor people, senior services, childhood education, and care for domestic violence victims cut off services to nearly 1 million Illinoisans. Hundreds of human service agencies were forced to lay off employees and slash their budgets with disastrous outcomes.

In some cases, these services still haven’t recovered.

The stories of upended lives were legion: A sexual assault crisis center in Urbana put rape victims on a three-month waiting list for counseling appointments; a social service agency in Chicago denied drug addiction treatment, domestic violence counseling and HIV prevention to hundreds of people; a senior service agency in Alton took on $3.5 million in debt, reduced Meals on Wheels services and warned that seniors are “starving and being left out in the cold.”

Most organizations weathered the storm, though it was costly. Some tapped into financial reserves or bank loans to get them through, in addition to shuttering programs and laying off or furloughing employees. Others relied on more desperate moves like using a board member’s 401(k) fund or illegally withholding payroll taxes. Many fundraised through bake sales. Some sold impasse-themed T-shirts.

But the impasse was less forgiving for some smaller operators in the poorer, sparsely populated towns throughout Illinois. They closed and never reopened, and there was no one else to do the work.

Then-candidate JB Pritzker seized on the resulting discontent and sailed to an easy victory over Rauner in 2018, with the Democrat promising to undo the damage. But in the decade since the state’s two-year budget stalemate began, recovery for social services has been uneven.

As governor, Pritzker has touted significant growth in spending under his administration; annual General Funds state spending on human services jumped by 60% from 2014 to 2024 — from $12.3 billion to $19.7 billion.

University of Illinois-Chicago professor David Merriman, who has long researched state finances, said Illinois’ economic picture has drastically improved more than he thought possible a decade ago.

“We’ve done better than I expected, quite honestly,” Merriman said. “We’re in much better shape than I thought we’d be.”

But that progress very well may be upended by large cuts to Medicaid benefits and cuts to housing and food assistance contained in congressional Republicans’ recently passed federal budget signed into law July 4 by President Donald Trump.

Illinois Collaboration on Youth Chief Executive Officer Andrea Durbin warned the state’s network of human services organizations is not equipped to handle an increase in need created by federal spending cuts, especially as social services agencies continue to struggle holding onto qualified employees.

“We'll see great demand and fewer resources and a … shrinking workforce to serve them,” Durbin said. “And so how can people prepare for something like that? I don't know that you really can.”

Illinois Deputy Governor for Health and Human Services Grace Hou, who ran the Department of Human Services during Pritzker’s first term, said she’d learned early on that “trust … can be easy to lose, but it's really hard to rebuild.”

She fears the coming federal cuts will undo years of progress.

“It's an earthquake, it's a tidal wave, it's a tsunami,” Hou said.

Illinois Deputy Governor for Health and Human Services Grace Hou appears alongside Gov. JB Pritzker at a Springfield news conference in 2023.
(Capitol News Illinois photo by Jerry Nowicki)
Illinois Deputy Governor for Health and Human Services Grace Hou appears alongside Gov. JB Pritzker at a Springfield news conference in 2023.

The impasse years

Rauner, who ran for governor in 2014 as a socially moderate Republican during the tail end of the GOP’s era of libertarian dominance, had a simple message for voters: Illinoisans’ tax dollars were being wasted by the “corrupt bargain” between Democrats who ran the state and public employee unions which he alleged inflate the cost of government services.

Two years before his victory against unpopular Democratic Gov. Pat Quinn, Rauner said he wanted “to drive a wedge issue in the Democratic Party” on the role of government in social services and bring in voters who’d rather “help the disadvantaged, the handicapped, the elderly, the children in poverty” than unionized government workers.

Before Rauner was even sworn in, he faced an immediate $6 billion structural deficit when a temporary hike to the state’s income tax rates expired on Jan. 1, 2015. The deficit would have to be made up by either other sources of revenue or cuts to state spending — or a combination of both.

Instead, after a spring of ever-worsening relations between the governor and Democrats who controlled the legislature, Illinois entered the new fiscal year on July 1, 2015, with no spending plan after Rauner vetoed most of the budget passed by the majority party.

Then-Gov. Bruce Rauner in late 2016, more than a year into Illinois’ budget impasse. The stalemate, which lasted two years, resulted from the ideological battle between the Republican governor and Democrats who controlled the General Assembly.
(Photo courtesy of the Better Government Association)
Then-Gov. Bruce Rauner in late 2016, more than a year into Illinois’ budget impasse. The stalemate, which lasted two years, resulted from the ideological battle between the Republican governor and Democrats who controlled the General Assembly.

Rauner did not respond to multiple messages for comment.

During the two-year stalemate, Illinois saw neither cuts to state spending nor new revenue sources. In fact, the state kept on spending due to a combination of constitutional mandates and a series of court rulings forcing the state to maintain certain services for vulnerable populations like the developmentally disabled.

Rauner himself took steps that ensured the impasse did not affect most voters, such as approving K-12 public schools spending and going to court to keep paying state workers.

The impasse lacked hallmarks that make federal government shutdowns a spectacle like airport security agents walking off the job or mass furloughs. The budget stalemate affected less than 10% of the state’s population, people who already live on the margins of society, including the poor, homeless people, children in foster care, people with disabilities, those struggling with addiction, and people suffering from domestic violence or gun violence.

Social services agencies that served those Illinoisans often weren’t covered by the patchwork of legal shields but were still obligated to fulfill their state contracts — many of which were even renewed during the two-year impasse — without any state funding.

The cuts to the state’s social safety net came fast and furiously. Some were temporary, others permanent.

‘It is so sad’

By the time the budget impasse began, the Stegles had settled into a life that was upended by tragedy. And they had done so with help from the state of Illinois.

The state had long funded the Delta Center, which hired the respite care worker they came to rely on, Becky Neathery. She knew how to bathe Cortnie, feed her, keep her calm. She was someone they felt safe leaving Cortnie with — and for the first time in many years, Judy and Mike could breathe on occasion. They even started going on an annual vacation, often to a beach in Mexico.

Then, one day, Judy received an unexpected call from Becky. She told her, “‘Judy, I gotta get a job, and there’s no more Delta Center.’ And it’s like, ‘Oh no.’ I mean, and it was just — it was gone!”

In addition to respite care, the Delta Center provided housing for homeless people and sex offenders, offered jobs to disabled adults, and after-school programming for at-risk teenagers in the small, impoverished city of Cairo, which has lost more than half its population in the last few decades. A total of 1,523 people lived there in 2024, according to census estimates.

Neathery described the organization’s closure as “devastating” for many rural families, including one that resorted to institutionalizing their disabled family member when their respite care services were cut off.

“Of course, when we found out funding was going to end, we sent a formal letter out to all the families, and I was actually at a home doing respite care when the family opened their letter and cried,” she recalled. “They just cried because they weren’t going to have it anymore.”

When the Delta Center closed, another provider, Vienna-based Family Counseling Center Inc., now known as Arrowleaf, took over some of its mental health programming.

Today, the once sprawling Delta Center campus is mostly deserted. Big white block letters spelling out the Delta Center’s name on a nearby brick sign are swallowed in a tangle of vines.

The Cairo-based Delta Center was one of the first victims of Illinois’ budget impasse in August 2015. Today, the once sprawling Delta Center campus is mostly deserted.
(Julia Rendleman for Capitol News Illinois)
The Cairo-based Delta Center was one of the first victims of Illinois’ budget impasse in August 2015. Today, the once sprawling Delta Center campus is mostly deserted.

The Cairo-based Delta Center was one of the first victims of Illinois’ budget impasse in August 2015. Today, the once sprawling Delta Center campus is mostly deserted. (Julia Rendleman for Capitol News Illinois) “The services that ended in Cairo have never come back to Cairo,” said Sandy McGregor, a former Delta Center accountant who lived in Cairo as a young adult but now lives across the border in Kentucky. “It is so sad.”

The impasse was especially hard on small towns in Southern Illinois, which lacked the economic power to weather the storm. If a housing nonprofit shuts down in a more populated area like Chicago or Bloomington-Normal, others are available to step up.

That’s not the case in places like Rosiclare, a city of 980 people along the Ohio River about 80 miles northeast of Cairo. In February 2016, the Mahoney Transitional Living facility, a homeless shelter for young adults in the Southeastern Illinois city, also closed its doors about a year after FCCI opened the residence.

Arrowleaf Chief Executive Officer Sherrie Crabb made the difficult call to shutter Mahoney, which she’d named after her first-grade teacher. As her organization tried to prioritize services during the impasse, Crabb said she went without pay for the better part of a year, while 37 employees were laid off.

Crabb was introduced to FCCI as an elementary schooler when she and her sister were briefly placed in foster care, and said it was “traumatizing” to inform the five or six youths and young adults there that they needed to leave the closing shelter.

“It was another traumatic experience for them of picking up and having to go somewhere else, thinking that they had found a safe and secure place and had the support that they needed,” she said.

The shelter had been funded through a state grant, but payments were halted when the impasse began. Crabb said the impasse taught her to view grants funded exclusively by the state as “risky,” and said the stalemate years forced her organization and many others like it to diversify their funding sources — especially to federal money, which up until recently was viewed as more stable.

In the years since, the state’s Department of Human Services has continued to put the grant out for bid, but Crabb said Arrowleaf “will never touch a homeless youth program again because of that experience that we had.”

The damage spreads

As the impasse dragged on, Illinoisans’ access to social services shrank rapidly, as tracked by regular surveys conducted by the United Way of Illinois. Within weeks of the new fiscal year’s start, more than a third of the roughly 400 respondents to the United Way’s survey reported they had already made cuts.

Six months into the stalemate, nearly half of the 444 human services providers that responded to the survey reported limiting the number of clients they could serve, shuttering entire programs or both. Layoffs were becoming more common, too.

Illinoisans who received mental health and addiction treatment services made up the largest share of the million Illinoisans who’d had services shut off to them by June 2016, although the impasse affected portions of nearly every other vulnerable population throughout the state.

Chart: Analysis by Casey Toner; Graphic by Cesar Calderon Source: The Governor's Office of Management and Budget

Rape Advocacy, Counseling, & Education Services in Urbana laid off its staff of eight workers and created an interim position to triage calls from sexual assault victims and people seeking protection orders.

“We were in a position of having to say, ‘I’m sorry we can’t help you and … no survivor deserves that,’” said Jaya Kolisetty, who became RACES’ interim leader during the impasse and is now executive director. “It can make it so people feel like there's … no clear purpose in reaching out for help, and that can be a really helpless position to be in.”

The Alton-based Senior Services Plus Inc. laid off 17 employees and scaled back its popular Meals on Wheels program, which served up to 700 people in St. Clair and Madison counties, according to Chief Executive Officer Theresa Collins. They went from doing wellness checks and delivering hot food to each senior five times a week to doing wellness checks and delivering five frozen meals to each senior once a week.

By the time the impasse ended, more than 100 seniors were on the Meals on Wheels waiting list.

“When we started calling them when funding got flowing ... several had been institutionalized or had died,” Collins said, adding that Meals on Wheels kept the once-a-week food delivery program as the number of their senior clients had ballooned to 1,100.

Though smaller nonprofits were uniquely vulnerable to the impasse, larger organizations suffered, too. Lutheran Social Services of Illinois, the single biggest human service provider in the state, sent shockwaves when it announced mass program closures and layoffs in mid-January 2016.

LSSI shuttered 33 programs that served 4,700 Illinoisans throughout the state, though the organization’s president and chief executive officer, Mark Stutrud, emphasized that efforts were made so that clients could be matched with other service providers. More than 750 staffers — roughly 43% of LSSI’s workforce — also were laid off.

The nonprofit scaled back youth services, including closing a youth shelter near Dixon, scaled back substance abuse treatment, shuttered nine mental health counseling centers and an adult day care, scrapped respite care for military families as well as reentry programs designed for inmates and their families in Alton, East Saint Louis and Chicago.

By the time of LSSI’s restructuring, the state owed the Des Plaines-based nonprofit more than $6 million and the organization had maxed out the bank line of credit it had been relying on for seven months and was “burning cash,” Stutrud said.

“We went too long because we thought this would get resolved, and they did not,” said Stutrud, who’d taken the helm at LSSI just a month before Rauner’s victory in the fall of 2014. “I don't believe anybody understood how long it was going to go. No one did.”

Kristen Ward, who recovered from heroin addiction at an inpatient program run by Lutheran Social Services and later worked as a nurse in an LSSI detox facility, is now a hospice nurse.
(Photo courtesy of Kristen Ward)
Kristen Ward, who recovered from heroin addiction at an inpatient program run by Lutheran Social Services and later worked as a nurse in an LSSI detox facility, is now a hospice nurse.

For Kristen Ward, the budget impasse was one more sign that she’d gotten treatment for her heroin addiction at the right time.

In 2013, after two decades of abusing painkillers spiraled into heroin use, the 41-year-old nurse and mother of two young boys finally reached rock bottom. Ward had started stealing to support her addiction. After multiple arrests and a conviction, she spent five months in the Will County Jail.

“You better take this seriously … because this isn't going to be available for everyone in the future,” Ward recalled being told during her 13-month stay at LSSI’s addiction treatment center in Chicago’s Edgewater neighborhood in 2013 and 2014.

A little over a year after she completed inpatient treatment, LSSI announced its mass layoffs and program closures. By that time, she was working as a nurse at LSSI’s newly opened detox center.

Ward’s job was safe but she worried for residents who “weren’t ready to go,” along with the detox patients she was helping through withdrawal — a brutal process she’d once gone through alone in a jail cell.

“It’s a vulnerable stage right after detox,” Ward said. “And if someone tells you they don't have a bed … and you're kind of left to your own devices, then you could convince yourself you could do it on your own, and then you're back out there, and then the cycle starts again before you know it.”

In the years after the impasse, LSSI opened new residential treatment programs to replace ones shuttered in 2016, including in Edgewater. But that wasn’t the case for the organization’s in-home care program for seniors, most of which was taken on by two for-profit businesses as part of LSSI’s restructuring. The program had been the largest segment of LSSI’s operations, serving roughly 2,500 seniors in more than two dozen Illinois counties at its peak.

Jane Massey, of Rock Island, worked as an office manager and helped with client intake of LSSI’s in-home care program in Moline. It served 130 seniors in Rock Island, Henry and Mercer counties.

LSSI sold the business to Help at Home, but the company laid off all 78 of its local employees, who were then told to reapply. Massey said the quality of care suffered when Help at Home moved its central office to Rockford.

“I can tell you that our staff members that were going out and taking care of these people they were getting — they were having such a hard time with communicating with that office,” Massey said. “They didn't return calls.”

Help at Home closed its Moline location in 2022 and fired Massey and the eight remaining workers.

In a statement, a Help at Home spokesperson called the budget impasse “a difficult period,” but said the organization maintained “uninterrupted home care” and preserved jobs after it took over LSSI’s portfolio.

Money flows again

After two years of compounding miseries, the Republican front folded in July 2017 when enough legislators joined the Democratic majority to override Rauner’s veto power, approving both a budget and an income tax rate hike to fund it.

State payments flowed once again, made easier after Comptroller Susana Mendoza borrowed $6.5 billion in a low-interest bond deal to pay off nearly half of Illinois’ staggering bill backlog.

After several years, the comptroller’s office was able to pay bills within 30 days — a figure that has since shrunk to an average of two weeks, and occasionally just one day.

But just because payments started flowing again didn’t mean social services agencies could immediately reopen their doors or ramp up capacity.

That impact could be seen at the Wells Center in Jacksonville, which provided drug addiction treatment for about 500 people each year but closed its doors in May 2017, one year shy of its 50th anniversary.

By the time the Wells Center became one of the last victims of the impasse, the state owed the nonprofit nearly $350,000. Shortly after being sworn in as comptroller in late 2016, Mendoza offered ways her office could pay a sliver of what the Wells Center was owed to keep it afloat. But the nonprofit’s leadership indicated it was likely too late.

“That's a perfect example of a group that was so far gone that no matter how much money we poured into it, they weren't going to survive,” she said.

The Wells Center’s facilities sat empty for months, but by the end of 2017, the Chicago-based Gateway Foundation had purchased the property. The new location opened its doors in June 2018.

llinois Comptroller Susana Mendoza defeated Gov. Bruce Rauner’s appointed Republican comptroller in a special election for the post in 2016, more than a year into Illinois’ budget impasse.
(Capitol News Illinois photo by Andrew Adams)
llinois Comptroller Susana Mendoza defeated Gov. Bruce Rauner’s appointed Republican comptroller in a special election for the post in 2016, more than a year into Illinois’ budget impasse.

Kasia Loniewska watched the budget impasse play out from Gateway’s offices in Springfield and is now the program director over the entire Jacksonville site. She said it was crucial for Jacksonville, a small city about 30 miles west of Springfield, to have intensive inpatient addiction treatment services — along with supportive housing for those in recovery — available for the surrounding rural areas.

“Other than Springfield, there was nothing and we knew that there's definitely a need for it,” said Loniewska, who credits her sobriety to a stay in a Chicago recovery home as a young adult. “Not everybody's able to relocate to Springfield and not everyone is able to afford the sober living facilities.”

For those in and around Jacksonville, whose roughly 18,000 residents make it the third-largest town in the part of western Illinois sometimes referred to as “Forgottonia,” the nearest inpatient offerings aside from Springfield are nearly 80 miles west in Quincy and more than 80 miles south in the Metro East.

The Gateway Foundation, an addiction treatment nonprofit, opened its Jacksonville location in 2018 after taking over the facility from the former Wells Center, which had performed addiction treatment work for nearly five decades before shuttering because of the budget impasse.
(Capitol News Illinois photo by Hannah Meisel)
The Gateway Foundation, an addiction treatment nonprofit, opened its Jacksonville location in 2018 after taking over the facility from the former Wells Center, which had performed addiction treatment work for nearly five decades before shuttering because of the budget impasse.

Recent funding infusion

Pritzker has often pointed to “historic investments” in human services during his tenure as governor, though he occasionally blames his predecessor when the state has fallen short.

When the governor’s director of the Department of Children and Family Services was held in contempt of court a dozen times in 2022 for the agency’s continued failure to place foster children in appropriate settings, the administration pointed to the loss of 500 shelter beds during the budget impasse.

More than 6 ½ years into Pritzker’s governorship, the number of state-funded youth shelter beds operated mostly by private agencies has not returned to pre-impasse levels, meaning some children still languish in psychiatric hospitals beyond medical need or remain in juvenile detention after their sentences end because they have no other place to go.

But other areas of human services, including homelessness prevention and anti-violence organizations — both hurt by the impasse — have seen an influx of cash from both state and federal sources.

The infusion of funding in recent years is evident in Illinois’ three of its largest state agencies that oversee human services: the Department of Human Services, the Department on Aging and the Department of Children and Family Services.

Chart: Analysis by Casey Toner; Graphic by Cesar Calderon Source: The Governor's Office of Management and Budget

Pritzker has boasted that doubling state funding to DCFS, which is subject to multiple federal consent decrees stemming from civil rights litigation spanning decades, has allowed the historically dysfunctional agency to grow its headcount from 2,615 in 2014 to 3,681 last year.

The number of children removed from their homes and in DCFS’ care, which child welfare experts label as a lagging indicator for unmet needs in other areas of human services, began climbing just after the impasse ended in mid-2017. The figure peaked at more than 21,000 at the end of Fiscal Year 2021, according to agency snapshot data, though some of that increase can also be attributed to the pandemic.

The overall spending increases on human services were helped by massive infusions of federal COVID-19 money, much of which the state distributed as one-time grants. The COVID money is reaching the tail end of its spending runway just as major federal cuts under Trump are beginning.

Illinois comptroller’s data shows that since 2022, the state has spent more than $10 billion in federal relief money, including $666 million in human services spending. That money allowed some nonprofits to boost their budgets and expand their services.

Lutheran Social Services of Illinois, which had a budget of $110 million before the budget crisis, and plunged to $79 million during the budget crisis, now has a budget of $157 million, said Stutrud, LSSI’s CEO.

Arrowleaf, which closed its young adult homeless shelter in Rosiclare, now operates in seven counties and has doubled its employee headcount since the impasse. Thanks in part to receiving more federal grants, Crabb, the nonprofit’s CEO, said her organization has increased its budget by about $10 million since the impasse to a high of $17.6 million in fiscal year 2024, though last year it fell to $15 million.

She even cited a $363,000 COVID-era “Rural Development Emergency Rural Health Care Grant” from the U.S. Department of Agriculture that Arrowleaf used to rehab its facility.

“It looks, probably, like one of the nicest buildings now in the city of Cairo,” Crabb said.

Federal cuts as deja vu

Some organizations like Arrowleaf have achieved steady budget growth in part through increased reliance on federal money, which has helped them meet higher levels of need brought on by COVID and the last few years of inflation and a shifting labor market.

But that strategy, adopted to shield social service agencies from future instability like Illinois’ budget impasse, has once again made organizations vulnerable to the current political moment.

Crabb said she had to lay off 10 Arrowleaf employees earlier this year due to state budget cuts and in anticipation of federal cuts even before Republican majorities in Congress approved the new budget in July, which includes significant reductions to Medicaid.

The “Big Beautiful Bill” is expected to cut Medicaid spending in Illinois by $46 billion over the next decade through new eligibility standards such as work requirements. It also limits the amount states can tax health care providers to pay for Medicaid — a lever Illinois has continually pushed to maximize federal match dollars for the program.

The view outside the governor’s second-floor office in the Illinois State Capitol building in Springfield. Above, the larger rail separates the House and Senate chambers.
(Capitol News Illinois photo by Andrew Adams)
The view outside the governor’s second-floor office in the Illinois State Capitol building in Springfield. Above, the larger rail separates the House and Senate chambers.

Paula Worthington, a senior policy advisor at the nonpartisan Civic Federation and lecturer at the University of Chicago’s Harris School of Public Policy, said Medicaid cuts may be more apparent in blue states like Illinois, which have chosen over years to be “more generous in terms of the services provided” by Medicaid dollars.

She cited Illinois paying for vision and dental care and offering longer timelines for new mothers and their babies to stay on a supplemental Medicaid program, which is offered regardless of immigration status.

“It's going to be more painful and obvious in states that have been more generous when that funding is cut back,” she said.

Pritzker has warned that more than 330,000 Illinois residents will lose health coverage as a result.

And just like the long-term damage done by the budget impasse, Worthington worried southern Illinois and other rural parts of the state will be hit the hardest by Medicaid cuts and the shuttering of services reliant on those federal dollars.

“You can see that in rural downstate counties, greater shares of the relevant population are reliant on these things,” Worthington said. “Cook County, too — don't get me wrong. … It's Cook County, and then it's downstate, rural communities that I think are most vulnerable.”

Illinois Deputy Governor for Budget and Economy Andy Manar acknowledged that challenges remain “not just in rural areas” but in historically underserved areas like Chicago’s south suburbs and shrinking population centers like Decatur and other mid-sized cities. Manar, a former state senator from rural Macoupin County, pointed to the human services agencies and programming that “cease(d) to exist” during the impasse.

“Rebuilding that has been a laborious process,” he said. “And by the way, that doesn't happen by spending less money. You don't rebuild DCFS … by hiring fewer people, by spending less money. You’ve got to spend more money.”

Left: Cortnie Stewart, whose traumatic brain injury in 1997 left her nonverbal, communicates with her mother Judy Stegle through facial expressions and hand signals. Right: Judy Stegle touches her daughter Cortnie Stewart’s wrist as Cortnie sits in the recliner in her bedroom, where she loves watching game shows like Press Your Luck and Family Feud.
(Julia Rendleman for Capitol News Illinois)
Left: Cortnie Stewart, whose traumatic brain injury in 1997 left her nonverbal, communicates with her mother Judy Stegle through facial expressions and hand signals. Right: Judy Stegle touches her daughter Cortnie Stewart’s wrist as Cortnie sits in the recliner in her bedroom, where she loves watching game shows like Press Your Luck and Family Feud.

In Jonesboro, Judy and Mike Stegle, now retired, take turns with the caregiving, never leaving 46-year-old Cortnie alone.

But they know they can’t take care of her forever. Judy touches her hands, her fingers swollen from arthritis. She’s not as strong as she used to be, and she’s so far been unable to persuade the state or insurance to subsidize her purchase of a mechanical lift for Cortnie.

But she’s not ready to think too far into the future.

“I’ve done this since, well, in my 40s,” she said. “Now I’m 72. … But it’s like, ‘well, darn — there’s nobody that cares.’”

Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.

This article first appeared on Capitol News Illinois and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Hannah covers state government and politics for Capitol News Illinois. She's been dedicated to the statehouse beat since interning at NPR Illinois in 2014, with subsequent stops at WILL-AM/FM, Law360, Capitol Fax and The Daily Line before returning to NPR Illinois in 2020 and moving to CNI in 2023.
Casey Toner, a Chicago native, has been an Illinois Answers reporter since 2016, taking the lead on numerous projects about criminal justice and politics. His series on police shootings in suburban Cook County resulted in a state law requiring procedural investigations of all police shootings in Illinois.
Veteran journalist Molly Parker joined Capitol News Illinois in July 2023 as an investigative reporter.